China’s Antibiotic Resistance Crisis

With the rise of highly resistant strains that carry a gene known as NDM-1, or New Delhi beta-metallolactamase-1, the misuse of antibiotics in India has received a lot of attemntion. However, China also has an out-of-control antibiotic resistance problem:

But a health care system that encourages doctors to churn out prescriptions, intensive marketing by pharmaceutical companies, and heavy use of antibiotics in animal husbandry and fisheries make China a special case. More than 60% of Staphylococcus aureus isolates from Chinese patients in surveyed hospitals in 2009 were methicillin-resistant—the dreaded MRSA—up from 40% in 2000. The proportion of Streptococcus pneumoniae isolates resistant to macrolides, meanwhile, now tops 70%. Roughly the same share of Escherichia coli isolates are resistant to quinolones—the highest rate in the world….

“Antibiotic resistance is a serious public health threat in China,” says Xiao Yonghong, an infectious disease specialist at Zhejiang University in Hangzhou. He oversees the Health Ministry’s National Antibacterial Resistance Investigation Net, which covers 80 hospitals nationwide. Drug resistance is most acute in densely populated cities in the east. Erythromycin-resistant S. pneumoniae, for example, appeared in 94% of isolates from children tested in hospitals here in 2004 and 2005. The sole strains of common drug-resistant bacteria not thriving in China are vancomycin-resistant Enterococci, Xiao says: “That’s the only good news.”

The absence of vancomycin-resistant enterococci (‘VRE’) is probably a result of China not having used avoparcin as a growth promoter in agriculture (good for them). But there are a lot of structural issues:

In 2010, the Health Ministry separated doctors’ pay from prescription drug sales. Its new directive goes further, by requiring that drugs be divided into three classes, with drugs with the highest resistance rates to be prescribed only by specialists. Violators can lose prescription rights or their medical license, while offending hospitals can be fined. But the government has not offered hospitals an alternative source of funding to replace drug profits. “A comprehensive overhaul” is needed, Reynolds says.

However, the largest problem is educational–and not just patients (boldface mine):

Even with further reforms, significant obstacles remain. In a survey in Guizhou Province in southwest China, Reynolds found that many doctors mistakenly believed their patients—not the bacteria inhabiting their bodies—had developed antibiotic resistance. Meanwhile, resistance is climbing. Says Zhu: “You now have genes resistant to almost every antibiotic available on the market.”

Not sure I would want a doctor who didn’t understand the basics of antibiotics doing anything to me, but that’s a separate issue.

As with so many other things, China has a large footprint. The West needs to start working with China to reduce antibiotic misuse and get the resistance problem under control.

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